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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.: 5308 
Inc Town:  
City: STEPHENSPORT  
No.  
St.  
Ward:  8th
Registration District No.:  
Primary Registration District No:  
File No.  27962
Registered No: 65 
2.	FULL NAME:  BLACK, WILLIAM B.
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  JUN 22, 1846
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  68 / 5 / 5
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  BLACKSMITH
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  JACOB BLACK
11.	BIRTHPLACE OF FATHER:  VIRGINIA
12.	MAIDEN NAME OF MOTHER:  SUSAN SNYDER
13.	BIRTHPLACE OF MOTHER:  ENGLAND
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  OSCAR BLACK
(Address)  ADDISON, KY
15.	Filed  NOV 28, 1914
REGISTAR:  R.A. SKILLMAN
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  NOV 27, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  NOV 23, 1914 to NOV 27, 1914
That I last saw him/her alive on (date):  NOV 26, 1914
And that death occurred on the date stated above at (time AM/PM):  4:35 PM
THE CAUSE OF DEATH was as follows:  APOPLEXY
(Duration)   Years:            Months:            Days:    5
Contributory:  SENILITY

(Duration)   Years:     5       Months:            Days:  
Signed (M.D.): J.L. LIGHTFOOT 
Date:  NOV 27, 1914
Address:  CLOVERPORT
18.	LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):  
In the State (yr, mo, da):  
Where was disease contracted,  if not at place of death?  
Former or usual residence:  
19.	PLACE OF BURIAL OR REMOVAL:  LODIBURG
DATE OF BURIAL:  NOV 28, 1914
20.	UNDERTAKER:  M. HAMMON & SONS
ADDRESS:  CLOVERPORT


ADDITIONAL COMMENTS/NOTES:




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